Nov/Dec 2006 - Volume 5, Issue 6

Emergency Preparedness
“Poker Run” Exercise in Kane County
Is a Great Success!

On a cold, windy, drizzling Illinois Saturday (November 4, 2006), some 25 hardy, well-clad biker members of the “Rescue Riders” organization, including men, women, husbands, wives, daughters, and best friends all wearing special red vests collaborated with staff of the Kane County Health Department; staff of the Fox Valley Chapter of the American Red Cross; and Kane County Medical Reserve Corps’ volunteers in the challenging inaugural “Poker Run” preparedness exercise. (1) “Poker runs” are popular with motorcyclists. Using poker runs to continuously improve county-wide disaster preparedness is an example of brilliant, out-of the-box thinking by leaders of the county health department and biker communities.   

The purpose of a preparedness run is to provide the opportunity for Rescue Riders to practice their navigational skills in rural and suburban Kane County, Illinois, as well as to apply their first aid, cardiopulmonary resuscitation, and disaster mental health skills in fictional scenarios.

Poker Run course organizers gave each Rescue Rider biker a new map (see above map) at each subsequent station or “stop”. For example, the first station was Illinois Math and Science Academy (IMSA) in Aurora, Illinois, where the group convened around 10 a.m. The second station stop was Kaneland High School in Maple Park, Illinois. The map provided at IMSA highlighted roads that were “non passable”--not really, only for the sake of practicing navigational skills. Bikers were permitted to cross non-passable roads, but not to travel along them to get from IMSA to Kaneland High School.

The rationale for making certain roads “non-passable” is that in a true disaster situation, roads may indeed by impassable (flooding, downed power lines, hazardous materials situation, bandits). Bikers transporting, say, critical materials (e.g., medications, vaccines, doctors, nurses) between points A and B need to learn all the roads in the county well—not only the main corridors--and practice emergent transportation problem solving through good map reading skills.

At each station stop, bikers were refreshed/tested on first aid skills, CPR, and disaster mental health by Kane County Health Department staff, Fox Valley Red Cross staff, and Medical Reserve Corps volunteers. For example, this writer was stationed at Fireman’s Park in East Dundee, Illinois. When the three groups of bikers arrived at 1:10 p.m., 1:25 p.m., and 2:10 p.m., they were asked: “Give an example of something you should NOT say to a disaster survivor.” Each rider received a single-page handout explaining key concepts of disaster mental health, created by the MRC staff. Correct answers (i.e., avoid saying these things to a disaster survivor) included: “It could have been worse,” “You can always get another pet/house/car”, “He is better off now, at least he went quickly”, “I know just how you feel”, and “You need to relax, grieve, calm down.”

Volunteers at each station shuffled a deck of stiff Harley-Davidson cards and offered the deck to each biker who then selected one card. This constituted the “poker” part of the emergency preparedness run. A volunteer recorded the card on a special orange card carried by each biker. The Rescue Rider with the best poker hand was to receive a prize at the conclusion of the Poker Run!

Each group’s times, recorded from the point of departure at IMSA to reaching East Dundee Fireman’s Park, calculated to the 2-3 hour range. Many people were a little surprised that navigation, using alternative roads to work around the “non-passable” roads to reach point the end of the course from its beginning, took as long as it did. Why this was so is the topic of ongoing discussion. This valuable observation will help improve emergency planning.

One biker unfortunately had an accident while making a turn. He injured his shoulder and a chip was taken out of his helmet. Paramedics arrived to the scene and transported him to a nearby emergency department for treatment (he did well, with “only” contusions). Two bikers in the group accompanied him to the emergency department. The three remaining bikers proceeded to East Dundee where they spread word of the accident.   

At IMSA, on-duty Kane County Sheriff’s Deputy Bill Latske visited the Rescue Riders as they prepared to start their journey. An avid motorcyclist himself, he wanted to join the Rescue Riders Poker Run on November 4, 2006, when he heard about it from an email sent out to all public safety officials by Michael Isaacson, emergency response coordinator, Kane County Health Department, on Friday, November 3, 2006. However, Latske had already signed up to work the Saturday shift for the Sheriff’s Department. So he satisfied himself with a short visit with the Rescue Riders at IMSA. Later when the Rescue Rider biker had the accident (see above), Deputy Latske heard about it via his police radio and went to the scene to help.

The final stop of the resilient bikers was “Sportsters Bar & Grill” in Geneva, Illinois. There, everyone warmed up and received prizes for the best poker hands and shirts for participation in the memorable inaugural MRC/Rescue Riders Poker Run.

A second similar Poker Run is currently being scheduled for spring 2007. Readers interested in obtaining more information should visit www.rescueriders.org for more information.

Notes:

1. For more on the Rescue Riders, Medical Reserve Corps of Kane County, and Fox Valley American Red Cross, please see the following:

• “Rescue Riders Biker Group and Kane County (IL) Medical Reserves Corp Join Forces” in Securitas September October 2006 (vol. 5, issue 6) available online at: http://www.semp.us/securitas/2006SeptOct.php; accessed November 11, 2006.
• Rescue Riders web page at: http://rescueriders.org/modules/news/; accessed November 11, 2006.
• Kane County Health Department at: www.kanehealth.com.
• Fox Valley Red Cross at: www.redcross.org/il/foxriver.

Maiden Voyage amid Rocky Shoals
“Psychological First Aid” Course
National Medical Reserve Corps

Psychiatrist Patricia Santucci, M.D., an eating-disorders and, more recently, a disaster mental health expert, led “Disaster Mental Health: Early Interventions—Psychological First Aid”, a new course she helped develop, before some 75 volunteer members of the Medical Reserve Corps (MRC) of Kane and surrounding counties in Illinois.

“Holiday” ship, Carnival cruise line. Source: http://ohioboating.net/b2/media/hurricane17.jpg; accessed November 10, 2006.

Pat Santucci, M.D., Elgin, Illinois, October 21, 2006. Photo by M. O’Leary.

The seven-hour course took place at Judson College in Elgin, Illinois, from 9 a.m. to 4 p.m. on a clear blue Saturday, October 21, 2006. The premise of the course was two-fold: 1) people experiencing a disaster may be traumatized and may need assistance to function normally, and 2) psychological intervention (also called “psychological first aid” and “psychological support”) may help “traumatized” people avoid development of chronic debilitating psychological effects resulting from the disaster experience.

Disaster researchers EL Quarantelli, Charles Fritz, and others who have studied populations in the field following disaster after disaster, disagree with the premise of the “Psychological First Aid” course—that people are “traumatized” and helpless during a disaster. These disaster researchers note with dismay that this premise is one of the most pervasive and unhelpful of all disaster myths. Fifty years of empirical evidence demonstrates that the overwhelming majority of people function well during and following disasters—sometimes even better than on “normal” non-disaster days, as described further below.

Medical Reserve Corps of Kane and surrounding counties, Illinois; October 21, 2006. Photo by M. O’Leary.

Audience member, Medical Reserve Corps, October 21, 2006. Photo by M. O’Leary.

Course Leader Santucci’s Katrina Experience

The National Medical Reserve Corps dispatched Santucci, who serves as medical director of the SW Florida Medical Reserve Corps, seven weeks AFTER Katrina struck on August 29, 2005. Her assignment was to provide mental health services to those who needed them among the 1,400 Katrina evacuees from the hardest hit part of Mississippi, lodged on the 1,452 passenger Carnival cruise ship “Holiday”. (1) The Federal Emergency Management Agency (FEMA) had leased the ship (and two others) for $192 million (for six months) from the Miami-based cruise line. (2)

Santucci and several mental health volunteers cared for 30-40 patients/day of all ages, with psychological needs ranging from prescription renewal to coping with stress. Santucci related to the audience that an official with the Federal Emergency Management Agency notified her that some 50 known pedophiles were aboard the ship.

Patrick DeMoon, Medical Reserve Corps, October 21, 2006. Photo by M. O’Leary.

Pat Santucci, M.D., with Bernard Parker, M.D., in Biloxi, Mississippi. Source:  http://www.medicalreservecorps.gov/ Image/P_Santucci_and_B_Parker.gif.

Santucci lamented that passengers were sometimes reluctant to ask for mental health services because of the “stigma” attached to receipt of those services. She worked in the ship’s infirmary alongside medical doctors to care for passengers with psychological problems.

National MRC Convenes Mental Health Work Group

Following her two-week stint on the “Holiday” cruise ship docked in Mobile, Alabama,  Santucci co-chaired the National MRC “Mental Health Work Group” with Dr. John K. Hickey, a social worker affiliated with the Nassau County (New York) MRC. (3)

The mission of the National MRC “Mental Health Work Group” was to “examine disaster mental health and psychological first aid training for the MRC [by] developing core competencies and reviewing various training programs presently available in disaster mental health.” (4) For example, the International Federation of Red Cross and Red Crescent Societies has published “Community-Based Psychological Support: A Training Manual”. (4a)

After clarifying the nature of “core competencies”, the Mental Health Work Group developed a “Psychological First Aid Field Operations Guide”. Assisting Santucci in development of the guide was James Schultz, PhD, an “epidemiology of AIDs” expert and, more recently, director of the “Disaster Epidemiology and Emergency Preparedness Center” at the University of Miami. In developing this guide, Santucci followed closely the ideas of the National Child Traumatic Stress Network and the National Center for PTSD (Post-Traumatic Stress Disorder) with which the MRC guide is prominently co-branded. (5)

Professor EL Quarantelli. Source: http://www.udel.edu/DRC/ Images/Quarantelli.jpg ; accessed November 10, 2006.

For her good works on disaster mental health and disaster response, Santucci on April 26, 2006 received from Florida Governor Jeb Bush a “Points of Light” award because, he said, “Many Floridians are learning the importance of preparation with the help of Patricia’s community programs.” (6)

What Is “Psychological First Aid”?

Santucci explains that psychological first aid “is an evidence-informed modular approach to assist children, adolescents, adults and family in the immediate aftermath of disaster or terrorism” to “reduce the initial distress caused by traumatic events” and “foster short and long-term adaptive functioning.” (5) She continues: “Psychological first aid should “at worse, produce no harm—at best provide effective ways to manage post-disaster stress and identify those that need additional psychological support.” (5) While psychological first aid has received “considerable” support from disaster mental health experts as the ‘acute intervention of choice’, Santucci points out that its efficacy and outcomes have NOT been empirically validated or rigorously tested. (5)

The Red Cross, which prefers the term “psychological support” to “psychological first aid”, defines “psychological support” as: “Any activity that improves a person’s ability to function under extraordinary level of stress observed in the context of a critical event.” (4a)  

Who Is the Target Audience for Psychological First Aid?

Santucci writes that “[i]ndividuals experiencing acute stress reactions or who appear to be at risk for significant impairment in functioning” are the target audience for receiving “psychological first aid”. (5) Santucci explained that these people could be identified by the “mile-long look” in their eyes. Santucci acknowledged data from New York City’s September 11, 2001 experience suggesting that most people work through the disaster experience without receiving psychological first aid and without developing post-traumatic stress syndrome (more below).      

Who Delivers Psychological First Aid?

All members of a Medical Reserve Corps who provide “acute assistance” as part of the organized disaster response” also provide “psychological first aid” to people affected by the disaster. All MRC volunteers should be trained in the proper MRC way to provide “psychological first aid”. (5) Non-mental health professionals can deliver psychological first aid.

When is Psychological First Aid Appropriate?

This type of psychological support is appropriate in the immediate aftermath of disasters and other traumatic events, declares Santucci. (5) It should “blend in” with the response structure early in the response and recovery period.

Where is Psychological First Aid Used?

Santucci suggests the following areas for application of this method: shelters, respite centers, field hospital emergency areas, emergency operations centers, first aid stations, phone banks, staging areas, family reception areas, family assistance areas, schools, decontamination areas, mass casualty collection points, and mass prophylaxis sites. (5)

How Does One Provide “Psychological First Aid”?

A “Psychological First Aid” volunteer should approach an adult in a disaster situation and say, “Hi, my name is [insert name here]. I’m with the Medical Reserve Corps. We’re checking with people to see if we can be of any help. Is it OK if I talk to you for a moment? May I ask your name? Mrs. Williams, before we talk, is there something right now that you need, like water or juice? “(5) Santucci underscores the need to “calm and orient emotionally overwhelmed or disoriented disaster survivors”.

Volunteers should always respect the privacy of those afflicted, according the “psychological first aid” materials. The majority of people will NOT need or want psychological first aid. Thus, volunteers must always ask permission to talk with people in a disaster situation, and must make NO assumptions about their being traumatized or their desire to talk.  

Acceptable “Psychological First Aid” Comments to the Stricken:  

1. “These are normal reactions to a disaster.”

2. “It is understandable and expectable that you feel this way.”

3. “You are not going crazy, intense emotions may come and go like waves.”

4. “It wasn’t your fault, you did the best you could.”

5. “Things may never be the same but they will get better and you will feel better.”

Unacceptable “Psychological First Aid” Comments to the Stricken:

1. “It could have been worse.”

2. “You can always get another pet/house/car.”

3. “He is better off now, at least he went quickly.”

4. “I know just how you feel.”

5. “You need to relax, grieve, calm down.”

Psychological First Aid Advocates Disparage Psychological “Debriefing”

Critical incident stress debriefing (CISD) is the wildly popular method developed by former Maryland Paramedic Jeffrey T. Mitchell in the 1970s. (7) It spawned the “grief industry”. The advocates of “psychological first aid” disparage the use of CISD. Psychological first aid providers are taught to avoid:

• Asking for “in-depth descriptions of traumatic experiences, as this may provoke unnecessary additional stress”, and
• Giving “blanket reassurance that stress reactions will disappear” as this may “set up unrealistic expectations, resulting in negative views of self”.

Santucci demonstrated deep breathing as one tool for application in “psychological first aid”. (5)

Quarantelli Debunks Faulty Assumptions Underlying “Psychological First Aid”

The underlying assumptions of disaster mental health services are that people (1) freak out in disasters and need help to function properly, and 2) are at risk for developing long-term psychological disabilities. This assumption is a tenacious disaster myth that keeps on giving.

John F. Kennedy was correct about myths: “Too often we hold fast to the clichés of our forebears. We subject all facts to a prefabricated set of interpretations. We enjoy the comfort of opinion without the discomfort of thought. Mythology distracts us everywhere. For the great enemy of the truth is very often not the lie: deliberate, contrived, and dishonest. But the myth: persistent, persuasive, and unrealistic.” (8)

The overwhelming majority of people do quite well mentally in disasters situations, says disaster researcher Charles Fritz. (9) In fact, he asks (rhetorically): “Why do large-scale disasters produce such mentally healthy conditions?” He emphasizes the “positive, beneficent, and therapeutic personal and social effects of disaster.” (9)

Disaster researcher E.L. Quarantelli rips the myth of “traumatized” victims in disasters, as follows (10): “The traumatic stress of a disaster experience is widely thought to have both short and long run negative consequences for the mental health of the individuals involved. Thus, supposedly some people are driven ‘crazy’, numerous others are so psychologically scared that they cannot function normally, and many seriously emotionally damaged victims are left behind. These pathological reactions are presumably manifested by almost all, or a majority of victims and may last indefinitely unless treatment is given.

“However, this image of disasters as inevitably creating many and serious mental health problems is another one of the prevailing major myths of disaster behavior. In reality community disasters at least very rarely, if ever, produce any new psychoses or severe mental illness. They neither appear at the time of impact nor emerge later in the recovery time period. (Even most preimpact hospitalized mentally ill persons react more or less in the emergency period in the same way as do other victims). Outpatient treatments by mental health clinics, visits to psychiatrists, admissions to mental health institutions, self reporting surveys of impacted populations, use of psychotherapy facilities, outreach programs to find people needing psychological counseling, etc., have consistently failed to show post impact rises which can be interpreted as signifying the appearance of serious mental health problem as a consequence of a disaster impact. (It should also never be forgotten that in any given community on any given day, there will be residents suffering from a variety of different kinds and severities of mental health and psychological problems: to argue that disasters bring about problems requires showing frequencies over and above the everyday rates which research studies have consistently failed to do; at least 15% according to some recent epidemiological surveys.”

Several thousand grief and crisis counselors arrived to New York City within weeks after September 11, 2001, because “experts” predicted that 1 in 5 New Yorkers—half a million people—would require psychological care, presumably to reduce the incidence of post-traumatic stress disorder. (7) Counselors were dispatched by charitable and religious organizations, public health jurisdictions and private companies that offer crisis services to companies following disasters.

Most New Yorkers received NO debriefing intervention following the terrorist attack on September 11, 2001. In October and November 2001, one telephone survey showed that 7.5 percent of a random sample of New Yorkers exhibited symptoms of PTSD (post-traumatic stress syndrome); but by March 2002, 1.7 percent suffered from prolonged PTSD. As distance from 9/11 increases, the percentage has dropped below 1%.

Psychiatrist Hyman. Source: http://www.provost.harvard.edu/ meet_provost/; accessed November 10, 2006.

Psychiatrist Steven Hyman, former head of the National Institutes of Mental Health and current provost of Harvard University, believes that mental health providers hold tightly to the disaster myth of traumatized victims needing intervention because: “Psychologists and psychiatrists are so interested in people, and they want to cure you with their understanding and empathy and connection…Debriefing holds more allure for most counselors, for it reflects a prevailing cultural bias; namely that a single outpouring of emotion—one good cry—can heal a scarred psyche…But it is the power of social networks that helps people create a sense of meaning and safety in their lives [not psychological first aid interventions].” (7) 

Summary

The Kane County MRC audience reportedly enjoyed the new “Psychological First Aid” course developed by the National Medical Reserve Corps and taught by psychiatrist and Florida MRC medical leader Patricia Santucci, M.D. Quarantelli and many other renowned disaster researchers, however, reject the premise of the course—that people need psychological interventions to cope with the mental trauma they are supposedly experiencing during disasters, and to stave off ultimate permanent mental meltdown. Empirical research on the topic, reaching back 50 years, has demonstrated that most people do very well psychologically and socially during disasters, often better than during “normal” non-disaster times. Perhaps “situational support” would be a more neutral and appropriate name for some of the ideas expressed in the various disaster mental health courses popping up everywhere. The removal to safety of; the feeding, clothing, and watering of; and the provision of human company to people affected by a disaster are NOT, of course, processes owned exclusively by people with a permanent professional psychological footprint in their heads.   

Sources:

1. “MRC Responder: Pat Santucci” at: http://www.medicalreservecorps.gov/Response/Hurricane/VolunteerStories/Santucci; accessed November 10, 2006.

2. “Coast residents moving to cruise ship,” September 28, 2005. Available at: http://www.nbc15online.com/news/local/story.aspx?content_id=B3409132-A5C2-4BCA-95D2-C9BB50F21CA1; accessed November 10, 2006.

3. National Medical Reserve Corp “Mental Health Work Group” available at: http://www.medicalreservecorps.gov/About/WorkGroups/MentalHealth; accessed November 10, 2006.

4. “MRC Update from the Program Office: December 2, 2005” at: http://www.medicalreservecorps.gov/POUpdates/2005/December/2.

4a. International Federation of Red Cross and Red Crescent Societies: “Community-based psychological support: A Training Manual” available at: http://www.ifrc.org/what/health/psycholog/manual.asp (accessed November 12, 2006).

5. For Power Point presentation, see: http://www.medicalreservecorps.gov/2006NLC/PDF/Santucci_Mental_Health.pdf
#search='john%20k%20hickey'; accessed November 10, 2006.

6. “Governor Bush Presents Points of Light Award to Patricia Santucci” at: http://www.medicalreservecorps.gov/NewsEvents/2006/SantucciPOLAward; accessed November 10, 2006.

7. “Does Post-Crisis Crisis Counseling Work?” (Sat 24 Jan, 2004) at: http://www.semp.us/biots/biot64.html; accessed November 10, 2006.

8. John F. Kennedy quote, June 11, 1962. Available at:  http://www.jfklibrary.org/Historical+Resources/Archives/Reference+Desk/Text+of+the+Orientation
+Film+for+the+John+F+Kennedy+Library.htm; accessed November 10, 2006.

9. Charles E. Fritz: “Disasters and Mental Health: Therapeutic Principles Drawn from Disaster Studies.” (1996). Available online at: http://www.udel.edu/DRC/preliminary/handc10.pdf; accessed November 10, 2006.

10. E.L. Quarantelli: “How Individuals and Groups React during Disasters: Planning and Managing Implications for EMS Delivery.” Available online at: http://www.udel.edu/DRC/preliminary/138.pdf; accessed November 10, 2006. For many more papers on disasters and mental health, please go to www.udel.edu and browse.

Great 1888 New York City Blizzard:
Disaster Prompted Replacement of Elevated Railroads with Subways

The Great Blizzard of 1888 in New York City was one of the most famous episodes of combined snow, wind, and cold recorded in recorded American and even world history. (1) A blizzard is a weather event characterized by winds of at least 35 miles per hour and temperatures of 20 degrees Fahrenheit or lower, combined with sufficient falling or blowing snow to reduce visibility to less than one quarter mile, according to the National Weather Service. (2) A blizzard is deemed “severe” when winds reach 45 miles per hour or more, temperatures fall to 0 degrees, and visibility is reduced to nearly zero. (2) All of these requirements were easily met in New York City during the Blizzard of 1888. Blizzards have an affinity for the upper Midwest and the Northeastern parts of the United States.

Meteorological map of 1888 storm. Source: http://whyy.org/tv12/franklinfacts/mar1201_1.jpg; accessed November 12, 2006.

Person on street during 1888 blizzard. Source: http://www.photolib.noaa.gov/ historic/nws/wea00971.htm; accessed November 12, 2006.

The Blizzard of 1888 in New York City began innocently enough on Sunday morning, March 11th, 1888, with mild rain. As the day wore on, the rain became heavier, pelting the city. Just after midnight, the temperature suddenly plummeted, converting the rain to sleet, which coated the sidewalks with ice. Then the blizzard began. At about 6:15 a.m. on Monday morning, little sunlight penetrated the clouds and “the air was burdened with soft, wet, clinging snow….The wind howled, whistled, banged, roared, and moaned as it rushed along. It fell upon house sides in fearful gusts, it strained great plate glass windows, rocked the frame houses, pressed against doors so that it was almost dangerous to open them.” (3)

The wind was so fierce that sparrows could not fly against it and many that tried rained dead from the sky. Some sparrows were observed resting in the windows of a newspaper building. When they started out against the air they stood still with wings fluttering vainly. If they attempted to fly with the gale they were hustled along like “stones thrown with fearful force.” (3)

The cold was so intense that the surface of the East River froze (for awhile until tug boats broke up the ice) permitting hundreds of people to cross on foot. The snowdrifts were so high that streets were blocked, and car tracks hidden. The streets were littered with horse cars lying on their sides, “blown-down signs, tops of fancy lamps, and all the wreck and debris of projections, ornaments, and movables.” Indeed the city’s surface was like a “wreck-strewn battlefield”. (3)

Crowd in NYC street, snow/ice on wires, blizzard 1888. Source: http://www.historyimages.com /Vintage-NY/Blizzard-88.htm; accessed November 12, 2006.

Children walking in NYC street, blizzard 1888. Source:  http://www.photolib.noaa.gov/historic/nws/wea00969.htm; accessed November 12, 2006.

As noon approached on Monday, March 12th, 1888, the storm continued its strange visitation. Even after dusk and into the night, the wind “roared and howled and bellowed and flung itself against the city’s walls”. One man fell into a snow drift, the story goes, sustaining a gash to his forehead. His head had struck the leg of a dead horse buried in the snow drift. “For some time afterward, the man showed his friends the wound and boasted that he was the first person ever kicked by a dead horse.” (4)

By 3 p.m., Monday, the city streets were mostly deserted as people gave up trying to move about. That Monday night, the blizzard continued and finally began to die down on Tuesday, March 13, 1888. About 22 inches of snow had fallen, drifting in places to 30 feet.

1888 Blizzard’s Impact on Elevated Railroads in New York City

1902 photo of NYC elevated train, showing curve in track. Source: http://www.schule.de/bics/son/ verkehr/hochbahn /andere/index.htm; accessed November 12, 2006.

Elevated train, NYC, at 110th Street, showing “Suicide Curve” in track. Source: http://www.allposters.com/- sp/Elevated-Train-110th-Street-New-York-City- Posters_i897032_.htm; accessed November 12, 2006.

Before there were subways, there were elevated railroads in Manhattan and Brooklyn. First constructed along Greenwich Street and Ninth Avenue in 1867-1870, they were alleviated the serious congestion on Manhattan and Brooklyn streets. The first rail cars were actually cable cars, pulled along by attaching to a moving cable beneath the train. In 1871, a new company called the “New York Elevated Railroad Company” tossed all the cable equipment and introduced the steam locomotives that pulled the trains along the track. Steam powered all subsequent elevated line locomotives until the advent of electrical operation in 1902. (5)

Before the blizzard of 1888, New Yorkers believed that a snow storm would not seriously affect the elevated railroads. In fact, the elevation of the railroad on trestles was considered a transportation advance in part because locomotion could continue in snowstorms when snow choked the streets. Then came the blizzard of 1888.

On Monday, March 12, 1888, elevated railroad men confronted four difficulties in running the elevated trains. First, the rails were slippery, which made rounding curves extremely dangerous and climbing steep grades or stopping within the required bounds at stations almost impossible. Trains that ventured out thus moved very slowly because of the slippery rails and the blinding, whirling snow that hid all objects at less than a block away. (6)

For example, one engineer in a downward train was pulling into a station when he suddenly saw a stopped train in front of him. He had not known that the northward blockade of trains had extended so far north. He applied the brakes, which had little effect because of the slipperiness of the tracks. The engine “bumped smartly” against the platform of the car in front, jostling passengers in both trains. (6)

Shoveling out a siding, blizzard NYC, 1888. Source: http://www.mce.k12tn.net/disasters/blizzard.htm; accessed November 12, 2006.

Locomotive wreck at Coleman’s Station, New York and Harlem Railroad, March 13, 1888. Source: http://nsidc.org/snow/gallery/; accessed November 12, 2006.

Second, the snow blocked the numerous sidings on which cars and locomotives were stored during the less active hours of the night. On a usual day, trains were made up in the morning to take passengers downtown, but on that Monday, employees were astonished at the height of the great snow drifts blocking access to the sidings. They attempted to clear away the snow, but as fast as it could be cleared away, the wind heaped up new snow in its place.

Third, the snow and ice caused problems at switch points (the moveable rail of the switch). A special force of men with brooms and pails of salt water worked to keep the movable rails in working order. They were confounded by salt water that kept freezing over in the pails. Whenever a train arrived at terminus the men had to loosen the rails to that the switch could be thrown over.

Fourth, the preceding three elements caused delays that added to the influence of inertia. It didn’t take long for a blockade to begin on the system of tracks, in which all active trains became backed up.

Passengers Attempt to Reach Work

In spite of the severity of the blizzard of 1888, about 50,000 New Yorkers valiantly attempted to travel to work using the elevated railroads, which were supposed to be relatively immune to snow storms. As mentioned above, the slow-moving and stopped trains were forming an ever-lengthening block of trains. Fewer trains were running because more could not be released from the sidings. Thus, some of the trains were “so heavily loaded that the bodies of the cars were depressed until the flanges of the wheels grated against the floors.” (6) Where there were curves in the track, the trains crawled along so as not to flip off the trestles. Guards at one station told the passengers about the delays because of the curves and most of the “standees” in the cars got off the train.

Passengers Use Ladders to Escape Elevated Trains

In one train at the Eighteenth Street Station was “loaded to the muzzle”, with people so packed in the seats, aisles, and platforms that “not even one small boy more could have gotten aboard”, according to a reporter who was able to board the elevated train. (7) The train began to move slowly at around 8:30 a.m. on Monday, March 12, 1888, but then stopped above Seventeenth Street where it remained for two hours. Then it moved ten feet more and stopped again for another hour. Finally, it reached a little below Sixteenth Street at around 3 p.m. on that same Monday, where it stopped once again.

Disillusioned passengers took desperate measures to reach the Fourteenth Street Station, less than two blocks away, or the street. The reported wrote: “A few clambered out on the west side of the cars to the foot-wide top of the iron wall, almost level with the car platforms, and balancing upon it, supporting themselves against the cars, walked to the station platform. Many got out on the east side and walked the ties to the same point. The ties were slippery, and, such as was the force of the gale much of the time, that whose who attempted these perilous feats were in imminent danger of being blown from the track into the street, and found themselves compelled to go on their hands and knees.”

“After a long time somebody in the street raised a ladder. It was too short to reach the track. To get on it one had to swing down and grope with his toes for the topmost round, seeing nothing, numbed and confused by the elements raging about him and the cold, hustled by others behind and himself crowding others in front in such eager haste on the part of all that the ladder was kept full of descending men for some time.

Digging out near the elevated train at Third Ave between 67th and 68th streets during the Blizzard of 1888. Source: http://www.vny.cuny.edu/Search/ search_res_image.php?id=339; accessed November 12, 2006.

Four men in snow drift. Blizzard of 1888, NYC. Source: Four men http://nsidc.org/snow/gallery/blizzard_1888b.html; accessed November 12, 2006.

“Then [someone] brought two ladders lashed together and so made long enough to extend above the side wall to the track so that it was comparatively easy of access. He charged twenty-five cents for each descent, by his route, standing at the top of the ladder and collecting from each person, shouting from time to time, ‘Look out down b’low, don’t let the ladder slip.’” (7)

The Elevated Train General Manager Speaks

By Thursday, March 15, 1888, all the elevated trains were again running and able to move New Yorkers around again. Colonel Hain and the rest of the railroad employees finally were able to rest after grueling work for the previous days. Hain had attempted to reach his office on Monday morning, March 12, 1888, but had only been able to reach Twenty-Third Street. That is when he realized the “big problem” that confronted him. (8) The gale was blowing at 60 miles per hour, filling the air with snow that blinded the eyes of the engineers. Three quarters of the train men were not even able to reach their stations and trains. Snow had accumulated to one foot deep OVER the rails with ice between them and the guards. He noticed that the wheels would not grip the rails and crowds wanting to be taken to work were triple the ordinary load.

Colonel Hain said, when it was all over, “I’m too tired to talk this morning. But the trains are running again.” Then he continued: “The tracks are clear. The gangs of shovellers and ice-pickers worked all yesterday and last night, and every inspector and inside man was on hand. The first care was to get the ice out of the switches and lubricate them. Afterwards there was a general clearing up and straightening out. Meanwhile we ran the trains as rapidly as possible. Luckily our telegraph and telephone wires were not injured and we were able to tell exactly where everything was throughout the whole system. And we’re all right now.” (8)

Many weeks passed before the last signs of the deepest snow drifts disappeared. One drift lasted until July 1888. (4)

Dangling Electrical, Telephone, Telegraph, Illuminating and Fire Alarm Wires

Sketch showing fallen wires, blizzard 1888, NYC. Source: Valentine's Manual of Old New York, 1927. Henry Collins Brown. 1926. Available online at: http://www.vny.cuny.edu/Search/ search_res_image.php?id=419; accessed November 12, 2006.

The blizzard ripped and blew down electrical, telephone, telegraph, and fire alarm wires, which dangled dangerously from poles or whipped around the streets. The elevated trains and their electric wires became not only useless but dangerous up there. Fire alarm wires also failed, disabling the system for notifying the firefighters had they been able to get out of their stations to suppress the fires, which they couldn’t.

Need for Subway

The blizzard of 1888 in New York City accomplished in days “what months, if not years of argument might have failed to do”—place the trains and various wires underground. One observer wrote: “Two things tolerably certain that a system of a really rapid transit which cannot be made inoperable by storms must be straightaway devised and as speedily as possibly constructed and that all the electric wires—telegraph, telephone, fire alarms, and illuminating—must be put underground without any delay.” (9)

New York Subway Construction 1900-1904

The first underground line of the subway opened on October 27, 1904. (10) Subway tunnels were constructed using a variety of methods, including the typical “cut-and-cover tunnel construction” The street was torn up to dig out the tunnel below, then the street was rebuilt above. This method worked well for soft dirt and gravel near the street surface. However, thicker sections made of bedrock required tunnel boring machines. (10)

Building the NYC subway 1900-1904. Source: http://www.nycsubway.org/perl/show?32163; accessed November 12, 2006.

Building the NYC subway 1900-1904: Source: http://www.nycsubway.org/perl/show?32172; accessed November 12, 2006.

Ten thousand men worked steadily for four years, excavating 3,508,000 cubic yards of earth and stone, according to one source. (11) One tunnel was 21 miles long. “The cost of excavating alone calculated to one-third of the entire outlay. Ingenious methods were used for the protection of the buildings, pipes, subways and vaults and the surface street-railway lines and surface traffic in general.”

The subways of Paris and London were built through clay and that of Boston entirely through earth, states the same source. (11) In the construction of the subway of New York, however, it was necessary to cut away nearly a million cubic yards of rock in the open and a half a million cubic yards of rock by tunneling. (11)

Summary

The Great Blizzard of 1888 in New York City is one of the most famous blizzards in human recorded history. It swept in suddenly and struck fiercely, paralyzing all of New York City, including its much-vaunted elevated railroad. The damage and economic standstill caused by the storm was the proof New Yorkers needed to put wires and trains underground. The blizzard precipitated reform.

Sources/Notes:

1. Other famous historical storms combining cold, wind, and snow include one in 763 A.D. that froze both the Black Sea and the Straits of Dardanelle in Europe; another in 1236 A.D. that froze the Danube River to the bottom, another in Flanders in 1468 A.D., that was so severe that soldiers’ wine rations had be cut with hatchets and distributed in frozen chunks, and a fourth one in Vienna in 1691 in which packs of wildlife moved into the city to find food. Source: “Blizzard of 1888: Still Most Famous” in “The Lima News”, page C11, Sunday, March 3, 1974.

2. For definition of blizzard, see: http://www.weather.gov/glossary/index.php?letter=b; accessed November 11, 2006.

3. “The Blizzard was King: The Metropolis Helpless under Snow” in “The New York Sun”, Tuesday, March 13, 1888. 

4. GJ Christiano: The Blizzard of 1888: the impact of this devastating storm on New York Transit” at: http://www.nycsubway.org/articles/1888-blizzard.html; accessed November 11, 2006.

5. GJ Christiano: “An Early History of New York City's First Elevated Railway” at: http://www.nycsubway.org/lines/9thave-el/; accessed November 12, 2006.

6. “Elevated Roads Helpless: Tens of Thousands of Passengers Caught between Stations” in “The New York Sun”, Tuesday, March 13, 1888. 

7. “By Elevated and by Ladder: Here’s a Specimen of the Fun 50,000 People Had Yesterday” in “The New York Sun”, Tuesday, March 13, 1888.

8. “Colonel Hain Runs his Trains” in “The New York Daily Graphic”, Thursday, March 15, 1888.

9. “In a Blizzard’s Grasp: the worst storm the city has ever known. Business travel completely suspended.” In “The New York Times”, Tuesday, March 13, 1888.

10. “History of the New York City Subway” at: http://www.arikah.net/encyclopedia/New_York_Subway#History; accessed November 12, 2006.

11. “New York Subway Souvenir 1904” at: http://www.nycsubway.org/articles/subwaysouvenir.html; accessed November 12, 2006.

Controlling the Tuberculosis Epidemic in New York City in 1900

Robert Koch’s discovery in 1882 of a staining technique that revealed the bacterium (Mycobacterium tuberculosis) that caused tuberculosis placed the disease in the group of infectious, communicable and preventable diseases. Across the Atlantic Ocean, in New York City, in 1881, tuberculosis was epidemic, particularly in “Lower New York”. In 1881, of 38,624 deaths recorded from Manhattan and the Bronx, 6,123 were caused by tuberculosis (total NYC population was 1,244,511). Of these 6,123 tubercular deaths, 5,312 were from pulmonary (lung) tuberculosis and the rest were from other types of tuberculosis (meningeal, kidney, spine). (1)

Robert Koch. Source: http://images.scotsman.com/ 2006/03/17/1703philob.jpg; accessed November 12, 2006.

Hermann M. Biggs. Source: http://www.hsph.harvard.edu/thegeo codingproject/webpage/monograph/biggs.gif; accessed November 12, 2006.

In 1887, Hermann M. Biggs, M.D., at the time general medical officer of the Department of Health, New York City, responded to Koch’s discovery of the etiology of tuberculosis by advocating a set of measures to control transmission of tuberculosis. Biggs believed that implementation of the measures required administrative action through enactment of certain regulations by the Board of Health, such as the sanitary surveillance of tuberculosis.  

The medical profession and the laity of NYC, however, had not sufficiently understood the importance of the matter. As a result, The Board of Health “considered it wise to adopt certain measures designed to extend information among the tenement house population as to the nature and the methods for the prevention of the disease.” (2)

In 1892 and 1893 Biggs again brought up the matter, but only in 1894 was the Board of Health ready to take definite steps to bring the tuberculosis under control. The Board adopted a “series of resolutions providing for a system of notification, partly compulsory and partly voluntary in character.

Map showing location of Lower East Side, NYC, site of many TB cases in 1900. Source: http://www.sublet.com/spider/AreaDesc /Manhattan/LowerEastSide.html; accessed November 12, 2006.

Tuberculosis sanitarium for female patients. Source: http://www.underworldtales.com/waverly.htm; accessed November 12, 2006.

First, public institutions of all kinds (hospitals, clinics, dispensaries) were REQUIRED to report all tuberculosis cases coming under their supervision within one week, while private physicians were REQUESTED to do so. (3)  Postcards and “blanks” were issued to hospitals and private physicians to fill out.

Second, once the tuberculosis cases were identified, Board of Health staff plotted them on a large map of the Boroughs of Manhattan and The Bronx (then constituting the City of New York).

Third, medical inspectors traveled to the premises of people identified as suffering from tuberculosis. If the tuberculous person was not under care of a physician, the inspectors left printed and verbal instruction informing the patient and family about what precautions they needed to take to prevent others from contracting the disease. 

When the premises were vacated by “the consumptive’s death or removal, the inspectors arranged for the removal of bedding, rugs, carpets, clothing, etc., for disinfection by steam, and for the cleaning, disinfection or renovation, as might be required, of the rooms occupied by the consumptive.” (4) These rooms were sometimes placarded, forbidding occupation by other persons until owners of the premises complied with the order of the Board of Health, requiring their renovation.

Fourth, the Board of Health set up a city-wide system to collect sputum samples and examine them for bacteria in the bacteriological laboratory of the Department of Health. Depots were set up at convenient points, “where sputum jars and blanks for recording information could be obtained, and where specimens of sputum for examination could be left. These were collected each day by the collectors of the Department, taken to the laboratory, examined, and a report forwarded to the physician of the result of the examination the following day.” (4) The rationale behind implementing this system was that ‘free examination of sputum would materially assist in the early diagnosis of tuberculosis, especially among the lower classes, and would encourage physicians to report cases.

In the first year of operation, the system identified some 4,000 cases of pulmonary tuberculosis and about 500 sputum samples were received for processing in the bacteriological laboratory. 

Incremental Steps

In 1897, the Board of Health extended the sanitary regulations relating to control of the smoldering tuberculosis outbreak. ALL entities, both private and public, and including every private physician, were required to notify the Board of Health of cases of tuberculosis, within 24 hours of its identification. The medical societies condemned the action, noting that it impinged on their power to deal with tuberculosis disease, and sent legislation to the New York State Legislature to withdraw the new sanitary rule. The medical societies were defeated. However, their constant pressure resulted in careful protection of the rights of both physicians and patients by the Board of Health such that “a constantly increasing proportion of the cases of tuberculosis were reported, while there was a steady decrease in the opposition to the regulations.” (5) 

Landlords and Janitors Pitch In

The Board of Health in 1902 adopted resolutions requiring the landlords and janitors of tenement and apartment houses to report to the Department the removal of any tenant suffering from tuberculosis, in order that proper disinfection might be performed by the Department of Health. (6)

More Hospital Beds Created for Tuberculosis Patients

In 1897 about 1,000 beds were occupied in NYC by patients with tuberculosis, and most of these beds were in large general wards. The Board of Health brought pressure on the management of hospitals to segregate this group of patients in wards or in separate buildings since the disease was contagious. As more and more advanced consumptives were removed from tenements to hospitals for treatment, the number of hospital beds created for their care rose to 2,500 by 1907.

Separate Pavilions for Non-Compliant Consumptives

In 1903, the Department of Health set aside several secure pavilions in one of its hospitals for contagious diseases for the special care of people with tuberculosis, who might comply with care. Interestingly, hospital managers were wont to dismiss non-compliant patients, where as the sanitary authorities knew that these patients were the most dangerous ones to be at large, because they would be spreading their disease. In May 1902, the Board of Health began to remove and retain consumptives to these pavilions, whether they were willing to enter or remain in a hospital or not.

Specially-Trained Tuberculosis Nurses

In 1903, a corps of trained nurses and medical inspectors evolved to provide “closer and more continuous supervision of the cases remaining in their homes.” The nurses visited these homes regularly, “making records of the surroundings, mode of living, physical and financial condition, temperature, observance of instructions and of any special needs. When it seemed desirable, recommendation for charitable assistance or for removal to a hospital was made.” (7)

Free Tuberculosis Clinics

Between 1904 and 1907, special tuberculosis clinics (also called “dispensaries”) evolved and were managed under the patronage of the “Tuberculosis Committee of the Charity Organization Society”. Even the Board of Health-operated  tuberculosis clinics were managed by the Tuberculosis Committee. Ambulatory consumptives who did not require hospitalization in a sanatorium obtained their care here.

Free Tuberculosis Sanitarium

In 1896 the Department of Health obtained a site for the establishment of a municipal tuberculosis sanatorium for incipient and early cases of tuberculosis at Otisville, New York, on a tract of land measuring 1,300 acres in the Shawangunk Mountains, about 75 miles form NYC. The elevation above sea level was form 900-1,300 feet. These sanitaria were for incipient and early cases of tuberculosis. Advanced cases were cared for in hospitals.

Regulations against Spitting in Public

No spitting sign. Source: Spitting http://www.bakkmarketing.com/ images/signs/spitting.jpg; accessed November 12, 2006.

Tuberculosis educational materials. Source: http://profiles.nlm.nih.gov/VC/ B/B/B/H/_/vcbbbh.jpg; accessed November 12, 2006.

As part of its educational campaign, the Board of Health began a crusade against “the filthy habit of spitting in public places. All street cars, elevated and underground railways, ferryboats, public buildings, piers, etc.” were heavily placarded with large signs against spitting. The sanitary police even made arrests of persons violating the law, and the newspaper delighted in publishing accounts of the transgression.

Incidence of Tuberculosis Death between 1881 and 1907

The incidence of death by tuberculosis declined from 6,123 consumptives (1881) to a low of 5,720 consumptives (1894) to a high of 6,809 consumptives in 1907. The total deaths from all causes was 38,624 (1881), 41,175 (1894), and 47,698 (1907). This calculates to 16% (1881) to 14% (1894) to 14% (1907). Oh well. The Board of Health’s attempt to control the outbreak was successful between 1881 and 1894 in the sense that tuberculosis deaths were not rising as the cause of all deaths among New Yorkers.

Table of data concerning tuberculosis in Manhattan and Brooklyn, 1881-1907. Source: “Brief History of the Campaign against Tuberculosis in New York City: catalogue of the tuberculosis exhibit of the Department of Health, City of New York, 1908,” p. 16. Reprinted by University of Michigan University Library from “The Michigan Historical Reprint Series”. See http://www.lib.umich.edu.

The strenuous work of the Board of Health could not compare in efficacy of tuberculosis control, however, with the efficacy of anti-tuberculous anti-infective streptomycin. On November 20, 1944, the antibiotic was administered for the first time to a critically ill consumptive. “The effect was almost immediately impressive. His advanced disease was visibly arrested, the bacteria disappeared from his sputum, and he made a rapid recovery. (8)

Sources:

1. “Brief History of the Campaign against Tuberculosis in New York City: catalogue of the tuberculosis exhibit of the Department of Health, City of New York, 1908.” Page 16. Reprinted by University of Michigan University Library from “The Michigan Historical Reprint Series”. See http://www.lib.umich.edu.

2. Ibid, p. 3.

3. Ibid, p. 4.

4. Ibid, p. 5.

5. Ibid, pp. 9-10.

6. Ibid, p. 10.

7. Ibid, p. 11.

8. “History of Tuberculosis Chemotherapy” at:  http://www.umdnj.edu/~ntbcweb/history.htm; accessed November 12, 2006.